Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study

Dongmei Wang; Meirong Li; Yue Pan; Zhenzhou Lin; Zhong Ji; Xiaomei Zhang; Miaoqin Tan; Suyue Pan; Yongming Wu; Shengnan Wang

doi:10.1177/17562864231214846

Risk factors for super-refractory and mortality in generalized convulsive status epilepticus: a 10-year retrospective cohort study

Ther Adv Neurol Disord. 2023 Dec 25:16:17562864231214846. doi: 10.1177/17562864231214846. eCollection 2023.

Authors

Dongmei Wang¹, Meirong Li², Yue Pan¹, Zhenzhou Lin¹, Zhong Ji¹, Xiaomei Zhang¹, Miaoqin Tan¹, Suyue Pan³, Yongming Wu³, Shengnan Wang^{3

4}

Affiliations

¹ Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
² Department of Dermatology and Venereology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
³ Department of Neurology, Nanfang Hospital, Southern Medical University, 1838 Northern Guangzhou Avenue, Guangzhou, Guangdong 510515, China.
⁴ Department of Critical Care Medicine, Baiyun Branch of Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.

Abstract

Background: Generalized convulsive status epilepticus (GCSE) is one of the most challenging life-threatening neurological emergencies. If GCSE becomes super-refractory, it is associated with significant mortality. Although aggressive management of prolonged status epilepticus was conducted, the mortality has not decreased since the late 1990s.

Objectives: The present study aimed to explore the risk factors for progression to super-refractory in patients with generalized convulsive status epilepticus (GCSE). Moreover, we illustrated the risk factors for mortality in GCSE patients.

Design: An observational retrospective cohort study.

Methods: We conducted a retrospective study of patients with GCSE admitted to our neurocritical unit, in Guangzhou, China, from October 2010 to February 2021. The data of sociodemographic information, etiology, laboratory results, treatment, and prognosis were collected and analyzed.

Results: A total of 106 patients were enrolled; 51 (48%) of them developed super-refractory status epilepticus (SRSE). Multivariate logistic regression analysis demonstrated that patients with autoimmune encephalitis (p = 0.015) and intracranial infection (p = 0.019) are likely to progress to SRSE. The in-hospital mortality was 11.8% and 9.1% for patients in the SRSE and non-SRSE groups, respectively (p = 0.652). Multivariate logistic regression analysis showed that neutrophil-to-lymphocyte ratios (NLR) at admission were independently associated with in-hospital mortality. Up to 31.4% of SRSE patients and 29.1% of non-SRSE patients died within 6 months after discharge (p = 0.798). Multivariate logistic regression analysis showed that plasma exchange (PE) was a protective factor for 6-month mortality. A high NLR at discharge was a risk factor for 6-month mortality.

Conclusion: In the current study, about 48% of GCSE patients progressed to SRSE. Regarding etiology, autoimmune encephalitis or intracranial infection was prone to SRSE. No significant differences were observed in the in-hospital and 6-month mortality between SRSE and non-SRSE groups. Multivariate logistic regression analysis showed that NLR at admission and discharge was an independent predictor of in-hospital and 6-month mortality, respectively. Moreover, PE significantly reduced the 6-month mortality.

Keywords: generalized convulsive status epilepticus/etiology; generalized convulsive status epilepticus/therapy; humans; intensive care unit; outcome.